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A Case Report: Thoracotomy in 64 years old Women with Thoracic Empyema Nugroho Sofian Aji; Darmawan Ismail
The Indonesian Journal of General Medicine Vol. 8 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/kpc8cq81

Background. Thoracic empyema, a serious complication of pneumonia, often begins with conservative treatments like thoracentesis and antibiotics in its early stages. However, the management of advanced empyema, particularly in stage II and III, remains contentious. Traditionally, open thoracotomy and decortication have been viewed as requiring lengthy recovery and extended hospital stays, leading some to favor thoracoscopic approaches for quicker outcomes. Objective. This study reports on the management of thoracotomy in patients with thoracic empyema. Case Report. A 64-year-old woman had been experiencing a cough with blood-streaked sputum for the past 2 months, which did not improve with medication. Further examination indicated thoracic empyema. An open thoracotomy was performed to manage the thoracic empyema. Conclusion. Open thoracotomy proves to be a beneficial approach for managing thoracic empyema. The procedure facilitates effective drainage and resolution of the infection, leading to improved recovery outcomes.

Propolis Extract Attenuates NF-κB Activation and Chronic Kidney Disease Progression in a Rat Model: Potential Surgical Adjuvant? Aulia Agung Sanubari; Darmawan Ismail; Kristanto Yuli Yarsa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i1.1167

Background: Chronic kidney disease (CKD) is a global health concern often complicated by cardiovascular diseases like atherosclerosis. Both conditions share an inflammatory pathogenesis, with nuclear factor kappa B (NF-κB) playing a central role. Propolis, a natural bee product with anti-inflammatory properties, has shown potential in mitigating CKD progression. This study aimed to investigate the effects of propolis extract on NF-κB activation in a rat model of CKD, exploring its potential benefits as a surgical adjuvant. Methods: Male white rats (Rattus norvegicus) were divided into three groups: a control group, a CKD group, and a CKD+Propolis group receiving propolis extract (200 mg/kg body weight) daily for 20 days. CKD was induced using the unilateral ureteral obstruction (UUO) method. NF-κB levels were measured weekly using ELISA. Results: Propolis extract significantly reduced NF-κB levels in the CKD+Propolis group compared to the CKD group (p<0.05). This effect was consistently observed across all time points, indicating a sustained reduction in NF-κB activation with propolis treatment. Conclusion: Propolis extract effectively attenuates NF-κB activation in a rat model of CKD, suggesting its potential as an adjunctive therapy for CKD management, particularly in the context of surgical interventions. Further research is needed to elucidate the underlying mechanisms and evaluate its efficacy in human subjects.

Vitamin D3 Supplementation as a Potential Therapeutic Strategy to Mitigate Inflammation in Chronic Kidney Disease: An NF-κB-Centric Preclinical Study Adly; Darmawan Ismail; Kristanto Yuli Yarsa
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.754

Chronic kidney disease (CKD) represents a global health burden, characterized by progressive loss of kidney function and a heightened state of chronic inflammation. Nuclear Factor-kappa B (NF-κB), a pivotal transcription factor, plays a central role in orchestrating this inflammatory cascade, contributing significantly to CKD progression and associated cardiovascular complications. Vitamin D deficiency is highly prevalent in CKD patients and is increasingly recognized for its potential role in exacerbating inflammation. This preclinical study aimed to investigate the therapeutic potential of Vitamin D3 supplementation in mitigating inflammation by modulating NF-κB levels in an experimental model of CKD. This study employed a post-test only control group design using 24 male albino Rattus norvegicus. CKD was induced, and animals were divided into three groups (n=8 each): a Control group (normal rats), a CKD group (rats with induced CKD receiving no treatment), and a CKD + Vitamin D3 group (CKD rats receiving Vitamin D3 supplementation for four weeks). Blood NF-κB levels were measured weekly for four weeks. Statistical analysis was performed using SPSS, including ANOVA and post-hoc Bonferroni tests, to determine significant differences between groups. NF-κB levels remained stable in the Control group. The CKD group exhibited a significant and progressive increase in blood NF-κB levels over the four-week period (mean at week 4: 657.50 ± 18.68 units/mL). Conversely, the CKD + Vitamin D3 group demonstrated a highly significant and time-dependent reduction in NF-κB levels, decreasing from a mean of 650.72 ± 24.92 units/mL at week 1 to 127.20 ± 4.46 units/mL by week 4 (p < 0.001 compared to the CKD group). Two-way repeated measures ANOVA revealed a significant interaction between treatment and time (p < 0.001). In conclusion, Vitamin D3 supplementation significantly attenuated the rise in blood NF-κB levels in this preclinical model of CKD in Rattus norvegicus. These findings suggest that Vitamin D3 holds promise as a therapeutic strategy to mitigate inflammation in CKD by targeting the NF-κB pathway. Further research is warranted to elucidate the precise molecular mechanisms and to translate these findings into clinical applications for human CKD patients.

Giant Pulmonary Bullae Complicated by Hospital-Acquired Pneumonia in Chronic Obstructive Pulmonary Disease: A Multidisciplinary Approach to Successful Bullectomy Hendra Rohmana; Darmawan Ismail
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.763

Giant pulmonary bullae (GPB), particularly in patients with chronic obstructive pulmonary disease (COPD), present significant management challenges due to compromised lung function. The development of hospital-acquired pneumonia (HAP) further complicates the clinical picture, increasing morbidity and mortality. This report details a case of GPB with HAP in a COPD patient. A 65-year-old male, a heavy former smoker with moderate COPD and a history of dust and wood smoke exposure, presented with progressive dyspnea and productive cough. Investigations revealed right-sided giant bullae occupying over 30% of the hemithorax, consolidation, and leukocytosis. Sputum culture grew Candida albicans, and intraoperative cultures later confirmed Streptococcus viridans HAP. Following initial medical stabilization with antibiotics, bronchodilators, and corticosteroids, he underwent an exploratory thoracotomy with bullectomy on day 14. In conclusion, the surgical intervention was successful, with no major complications. Post-operatively, the patient showed significant improvement in respiratory symptoms and lung expansion. This case highlights the efficacy of a multidisciplinary approach, combining intensive medical therapy with timely surgical bullectomy, for managing complex presentations of GPB, HAP, and COPD, leading to favorable outcomes.

Mature Teratoma of the Mediastinum in an Adolescent: Clinical Camouflage as Meningioma with Hemoptysis and Pleural Effusion Adi Astron Prasetio; Darmawan Ismail
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.765

Mediastinal mature teratomas are relatively common germ cell tumors in adolescents, typically located in the anterior mediastinum. While often benign and slow-growing, they can cause symptoms like hemoptysis through compression or local invasion. The differential diagnosis can rarely include ectopic meningioma, posing significant diagnostic challenges. The aim of this report is to describe this unusual presentation of a mediastinal mature teratoma and to emphasize the importance of a comprehensive, multidisciplinary diagnostic workup for achieving an accurate diagnosis and guiding appropriate management in such complex cases of mediastinal pathology. A 17-year-old female presented with a two-month history of blood-streaked hemoptysis and intermittent central chest pain. She had no systemic symptoms such as fever or weight loss. Physical examination was largely unremarkable, though laboratory tests revealed mild anemia (Hb 9.2 g/dL). Imaging studies, including chest X-ray and contrast-enhanced thoracic multi-slice computed tomography (MSCT), identified a large, heterogeneous anterior to middle mediastinal mass. The mass was noted to compress the right main bronchus, causing right lower lobe atelectasis, and was associated with minimal right-sided pleural effusion and mediastinal lymphadenopathy. The MSCT findings were suggestive of a teratoma. A core biopsy of the mediastinal mass indicated a mature teratoma but also raised meningioma as a differential diagnosis. Bronchoscopy revealed mucosal hyperemia and hypervascularity in the tracheobronchial tree. A brain MRI was negative for intracranial metastasis. The patient was managed conservatively pending further comprehensive evaluation and multidisciplinary team discussion. In conclusion, this case underscores an atypical presentation of a mediastinal mature teratoma in an adolescent, characterized by hemoptysis, pleural effusion, and a rare histopathological differential of meningioma. It highlights the critical role of meticulous and comprehensive diagnostic evaluation, including advanced imaging and histopathology, along with a multidisciplinary approach, in accurately diagnosing and planning the management of such complex mediastinal masses, especially when faced with unusual clinical or pathological features.

Propolis Extract Attenuates NF-κB Activation and Chronic Kidney Disease Progression in a Rat Model: Potential Surgical Adjuvant? Aulia Agung Sanubari; Darmawan Ismail; Kristanto Yuli Yarsa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i1.1167

Background: Chronic kidney disease (CKD) is a global health concern often complicated by cardiovascular diseases like atherosclerosis. Both conditions share an inflammatory pathogenesis, with nuclear factor kappa B (NF-κB) playing a central role. Propolis, a natural bee product with anti-inflammatory properties, has shown potential in mitigating CKD progression. This study aimed to investigate the effects of propolis extract on NF-κB activation in a rat model of CKD, exploring its potential benefits as a surgical adjuvant. Methods: Male white rats (Rattus norvegicus) were divided into three groups: a control group, a CKD group, and a CKD+Propolis group receiving propolis extract (200 mg/kg body weight) daily for 20 days. CKD was induced using the unilateral ureteral obstruction (UUO) method. NF-κB levels were measured weekly using ELISA. Results: Propolis extract significantly reduced NF-κB levels in the CKD+Propolis group compared to the CKD group (p<0.05). This effect was consistently observed across all time points, indicating a sustained reduction in NF-κB activation with propolis treatment. Conclusion: Propolis extract effectively attenuates NF-κB activation in a rat model of CKD, suggesting its potential as an adjunctive therapy for CKD management, particularly in the context of surgical interventions. Further research is needed to elucidate the underlying mechanisms and evaluate its efficacy in human subjects.

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